Treatment with Direct-Acting Antivirals in Patients with HCV Infection After Liver Transplantation

Sep 30, 2026

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Direct-acting antivirals (DAAs) have transformed chronic hepatitis C management, yet real-world evidence on their effectiveness and safety in recipients with prior orthotopic liver transplantation (OLTx) remains limited. This nationwide, retrospective cohort study assessed clinical characteristics, outcomes, and tolerability of DAA therapy in 141 adult liver transplant recipients with chronic HCV from the EpiTer-2 project. SVR reached 96.4% (ITT) and 98.6% after excluding losses; treatment was well tolerated with serious adverse events in five patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Global burden and disease progression

Treatment challenges in transplant recipients

Article Treatment with Direct-Acting Antivirals in Patients with HCV Infection After Liver Transplantation Michał Brzd˛ek 1,2, *, Dorota Zar˛ebska-Michaluk 3, Olga Tronina 4, Łukasz Laurans 5,6, Ewa Janczewska 7, Dorota Dybowska 8, Anna Parfieniuk-Kowerda 9, Magdalena Tudrujek-Zdunek 10, Jolanta Białkowska-Warzecha 11, Justyna Janocha-Litwin 12 and Robert Flisiak 9 Academic Editors: Hidekazu Suzuki and Emanuele Pontali Received: 6 October 2025 Revised: 4 December 2025 Accepted: 30 December 2025 Published: 2 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland 2 Department of Gastroenterology, Medical University of Lodz, 92-213 Lodz, Poland 3 Department of Infectious Diseases and Allergology, Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; [dorota1010@tlen.pl](dorota1010@tlen.pl) 4 Lazarski University, 02-662 Warsaw, Poland; [olgatronina@wp.pl](olgatronina@wp.pl) 5 Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University, 70-204 Szczecin, Poland; [asklepiada@wp.pl](asklepiada@wp.pl) 6 Multidiscyplinary Voivodship Hospital, 66-400 Gorzów Wlkp, Poland 7 ID Clinic, 41-400 Mysłowice, Poland; [e.janczewska@poczta.fm](e.janczewska@poczta.fm) 8 Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-030 Bydgoszcz, Poland; [d.dybowska@wsoz.pl](d.dybowska@wsoz.pl) 9 Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Białystok, Poland; anna.parfieniuk@gmail.com (A.P.-K.); robert.flisiak1@gmail.com (R.F.) 10 Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland; [magdalena.tudrujek@gmail.com](magdalena.tudrujek@gmail.com) 11 Biega ´nski Regional Specjalist Hospital, 91-347 Łód´z, Poland; [jolanta.e.bialkowska@gmail.com](jolanta.e.bialkowska@gmail.com) [12](12 Infectious Diseases and Hepatology Clinic)[ Infectious Diseases and Hepatology Clinic](12 Infectious Diseases and Hepatology Clinic), [Medical University of Wroclaw](Medical University of Wroclaw), [50-367 Wroc](50-367 Wroc)ł[aw](aw), [Poland](Poland); [justyna@janocha-litwin.pl](justyna@janocha-litwin.pl) * [Correspondence: michal.brzdek@gmail.com](Correspondence: michal.brzdek@gmail.com) Abstract Background/Objectives: Direct-acting antivirals (DAAs) have revolutionized the management of chronic hepatitis C virus (HCV) infection. However, real-world data on the effectiveness and safety of DAA therapy in patients with history orthotopic liver transplantation (OLTx) remain limited. This study aimed to evaluate the clinical characteristics, effectiveness, and safety of DAA therapy in liver transplant recipients with chronic hepatitis C in a nationwide, real-world cohort. Methods: A retrospective analysis was performed of all consecutive adult patients who underwent OLTx before starting DAA therapy between July 2015 and December 2024 within the EpiTer-2 project, which included 20,586 patients treated because of chronic hepatitis C. Results: A total of 141 patients participated in the study, with most of them being men (66%) and aged 50 years or older. Most patients (80%) had comorbidities, and nearly a quarter of the population had cirrhosis of the transplanted liver at the start of antiviral therapy. The median time from OLTx to initiation of antiviral therapy was 24 months. Overall, SVR was achieved in 96.4% of patients in the intentionto-treat analysis and in 98.6% after excluding patients lost to follow-up. The treatment was well tolerated. Serious adverse events were reported in five patients. During DAA treatment and 12 weeks of follow-up after treatment, two deaths were reported. Sub

FAQs

What was the main goal of this study?

To evaluate clinical characteristics, effectiveness, and safety of DAA therapy in liver transplant recipients with chronic hepatitis C using a nationwide real-world cohort.

How effective was DAA treatment in achieving SVR?

SVR was achieved in 96.4% of patients in the intention-to-treat analysis and 98.6% after excluding patients lost to follow-up.

What safety outcomes were reported during treatment?

The treatment was well tolerated; serious adverse events were reported in five patients, and two deaths were recorded during DAA treatment and 12 weeks of follow-up.

Sep 30, 2026

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